Janet Daley was born in America where she began her political life on the Left as an undergraduate at Berkeley. She moved to Britain (and to the Right) in 1965 where she spent nearly twenty years in academic life before becoming a political commentator: all factors that inform her writing on British and American policy and politicians.

Here's a health reform that even a gutless government can introduce

Alan Milburn's accusation that the Government has actually gone backwards on reforming the NHS – ending up with a system that will offer patients less and cost the taxpayer more – ought to be the last straw. It is difficult to recall a more catastrophic loss of political nerve in terms of actual consequences for ordinary people.

But we are where we are. The NHS as it stands to be "reformed" will face financial insolvency unless it is bailed out with even more Treasury money than has been thrown at it over the past decade. It is now imperative that it receive extra revenue from somewhere other than taxation. So here is a policy suggestion which has the advantage of not requiring primary legislation (and is therefore less likely to provoke the orchestrated resistance of opportunist politicians): change the Department of Health guidelines so that patients who choose to "top up" their free national health care with private treatment cannot be disbarred from NHS provision. (Which is absurd in principle, anyway. Every time you go to the chemist and buy a bottle of cough mixture, you are "topping up" your NHS care with your private funds.)

Cancer patients who want to buy drugs that have been made unavailable by NICE, people who want to pay for extra tests which their GP will not recommend, accident victims who want to arrange for their own physiotherapy – they should all be free to do so without fear of being cast out of the NHS altogether because they have crossed the Berlin Wall and defected to the "private sector".

In fact, quite a few hospital trusts already permit such mixing and matching even though it goes against the official DoH policy, but too many insist that just one blood test or x-ray carried out by a private provider is enough to exclude a patient from NHS teatment for his condition. So if ever there was an example of an unfair "postcode lottery" this is it.

All that is required is that the internal guidelines be amended. And then do you know what would happen? "Top-ups" would become a normal, accepted adjunct to the free medical service. So private medical insurance would leap into a ready market and produce cheap, accessible "top-up only" policies offering a range of coverage options (from "drugs only" to, say, lab tests and optional procedures). The payment for these "extras" would be shared between the private provider and the NHS. The extra income into the NHS pot would help to fund the expansion of its facilities, so those who were not paying to "top-up" would be helped too. Everybody wins.

But why, you might ask, should the private sector be prepared to share the profits of its services with the NHS? Because this system would greatly increase its volume of business. Instead of dealing only with people who can go for exclusively private treatment, it would now have a huge market in customers who wanted to use private add-ons only occasionally (and who buy cheap insurance to cover that possibility). Again, everybody wins. The NHS gets an additional revenue stream, medical insurance becomes much more varied and useful to more people, and patients get far greater choice and freedom. Isn't that what we are all supposed to want?